Iatrogenic Tracheobronchial Lesions - A Report on 13 Cases1

Abstract

While technical problems of tracheobronchial reconstruction in our series were controllable, the long-term results were not satisfying. Our data suggest that the key for better outcome of these kind of lesions lies in an early diagnosis and immediate treatment, thus keeping the trauma-treatment interval with the concomitant hypoxic damage as short as possible.

Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture? Clinical Analysis of a Thoracic Surgeon’s Opinion

“…The study that reported the highest mortality (61.5%) did not have repair-site problems, and all causes of death were nonsurgical, such as the sequelae from trauma-related hypoxia, underlying diseases (malignancy), or septic multi-organ failure. 7) Thus, the prognosis depended on the underlying disease rather than on tracheal damage. 20) Similar results were described in the other study, in which overall mortality from tracheobronchial rupture was 16.8%; 8) however, tracheobronchial rupture-related mortality in surgical patients was 2.2%.…”

“…It is difficult to conclude that conservative treatment is superior to surgery despite the fact that the reported absolute mortality due to surgery is higher than that of conservative treatment. The cause of the high surgical mortality was obtained from two reports 7,8) because 63.6% of all mortalities originated from these two reports. Excluding those two reports, the overall mortality rate in surgery-preferred group is 9.2%.…”

Treatment of iatrogenic and traumatic tracheal disruptions

“…Mortality rates as high as 60% are reported after surgical treatment of tracheal disruptions [2,5,30,31]. Co-morbidities and/or underlying severe clinical conditions may significantly affect the overall mortality rate after surgery.…”

Conservative management of iatrogenic tracheal injury

“…Oko jedne trećine pacijenata sa povredom traheobronhijalnog stabla nema simptome i znakove istog 7 . Karakterišu je simptomi i znaci koji se u odnosu na vreme nastanka mogu podeliti na rane -koji nastaju neposredno nakon povrede i kasne -koji nastaju čak i do nekoliko dana ili meseci nakon nastanka povrede.…”

“…Traheja se intubira, preporučljivo je primenom fleksibilnog bronhoskopa, da bi se ostvarilo adekvatno pozicioniranje trahealnog tubusa. Pozicija trahealnog tubusa podrazumeva da se kaf lokalizuje ispod lezije, u cilju sprečavanja kompromitacije krvotoka, što može usporiti ili onemogućiti zarastanje 2,7 . Uzevši u obzir visoku učesta-lost intraoperativnih i postoperativnih komplikacija i dodatno povećavanu učestalost mortaliteta, po nekim studijama do 71%, konzervativni tretman se izvodi kod rascepa većih od 3 cm kada opšte stanje pacijenta dozvoljava.…”